Topline: Congress is acting to protect Americans who, through no fault of their own, have received an unaffordable surprise medical bill. We’re acting to protect people like Sonji Wilkes, who received a $50,000 surprise bill because her newborn son stayed 50 steps from her in the NICU for night.
The Problem:
-A recent study shows nearly 1 in 5 visits to the emergency room results in a surprise medical bill. This is not a small problem and those are not good odds; it could happen to anyone.
The Solution:
-Surprise billing is not right. It is not fair; and, it is hurting Americans.
-If hospitals, doctors, and insurers mean what they say – that patients should be held harmless and that patients are not responsible – then let’s pass the No Surprises Act.
-This legislation would:
-Prohibit surprise medical bills – holding patients harmless when they experience a medical emergency or simply have no ability to determine if they are receiving care from an in-network or out-of-network provider.
-Increase transparency and empower patient choice – so people can better understand what their plans cover and what costs are before scheduled care.
-Establishes a market-based benchmark (dependent on geographic location + type of care provided) to resolve out-of-network payment disputes and includes an important backstop, so providers can challenge the compensation – if the median in-network benchmark payment exceeds $1,250 – through an independent dispute resolution process, where the complexity of care and quality of the provider’s services is considered.
Additional Talking Points:
-This is about fairness. Patients who should be held harmless in these disputes.
-Our approach is based on the principles of fairness and federalism.
-The payment disputes are resolved with a market-based benchmark dependent upon where you live and the care you receive. Also, there is an independent dispute resolution process.
-This proposal will save the federal government tens of billions of dollars and create downward pressure on health care costs for patients. That matters.
Note: The No Surprises Act was included in H.R. 2328, the REACH Act, as part of an Amendment in the Nature of a Substitute.
Find additional E&C Surprise Billing resources here